Healthcare Provider Details

I. General information

NPI: 1699747584
Provider Name (Legal Business Name): CLEMENTE SOLANTE ESTRERA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWDMC, 7TH ALBEMARLE
PETERSBURG VA
23803
US

IV. Provider business mailing address

12930 CHESDIN LANDING DR
CHESTERFIELD VA
23838-3234
US

V. Phone/Fax

Practice location:
  • Phone: 804-525-7420
  • Fax: 804-524-4828
Mailing address:
  • Phone: 804-590-3773
  • Fax: 804-590-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101027965
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: